Besides exposing the rickety healthcare system and abysmally low public spending on the sector over the decades, the coronavirus pandemic has brought into sharp focus the country’s skewed priorities when it comes to addressing the challenges from infectious diseases.
India carries a disproportionate burden of global infectious diseases, particularly the ones of zoonotic origin. The rapid urbanisation has increased mobility and density, raising new challenges to sanitation and healthcare. There are other environmental, demographic, socio-economic factors and changes in the agricultural practices that introduce zoonotic pathogens and put India at a strong risk for communicable diseases.
The infectious diseases account for about 30 per cent of the disease burden in India. However, only a few infectious diseases are prioritised in the vertical control programmes managed by the Central government, and even among these diseases only the control of HIV and leprosy seems to be successful.
The outbreaks of Nipah in Kerala and acute encephalitis syndrome in Bihar in the recent times have exposed the gaps in public healthcare system such as weak surveillance, lack of public awareness, poor nutrition, sanitation and ill-equipped health facilities.
“There are shortcomings in local responses at a crucial stage in infectious disease management. Multi-sectoral coordination at this early, local stage play an important role in containing diseases,” a research paper published by the Observer Research Foundation (ORF) said.
Experts point out that the infectious diseases that are not in the vertical control programmes are mostly neglected, with no formal monitoring or control system at the population level.
India is a textbook for anyone wishing to study infectious diseases. Many infectious diseases can be prevented in individuals and controlled in the community with a robust public health system and adequately trained public health personnel.
Functional integration of vertical programmes and their coordination with the healthcare system, which is managed by state governments, is needed for efficient and sustainable reduction of the burden of a wide range of infectious diseases.
Step up public funding
Poor public spending on healthcare is a key hurdle in the fight against infectious diseases. At present, India’s expenditure on healthcare accounts for 1.17 per cent of the GDP, one of the lowest in the world. By 2025, it is targeted to go up to 2.5 per cent, when the average for the rest of the world is expected to be nearly six percent.
Similarly, the country’s investment in Research and Development (R&D) remained stagnant at about 0.9 per cent of the GDP over the last ten years.
It has become a ritual for every Prime Minister over the years to reiterate at the annual Science Congress that the government is committed to increase the R&D spending to 2 per cent of the GDP. Beyond such grand statements at gatherings of scientists, nothing much happens on the ground.
India has one of the lowest density of health workforce with density of physicians being 7 per 10,000 population and nurses 17 per 10,000 population as against the global average of 13.9 and 28.6 respectively.
“This is very serious issue, particularly in the rural areas as most doctors and hospital beds are concentrated in urban areas catering to only 20% of India’s population,” says Kayzad Soli Nilgiriwala of the Foundation for Medical Research.
Being a country of extreme geo-climatic diversity, India faces a constant threat of emerging and re-emerging viral infections. “There is a need for strengthening disease surveillance in the country focusing on the epidemiology and disease burden and also the emergency preparedness for these diseases,” he says.
Many strategies designed to handle the challenges of infectious diseases in India are broad and meant to tackle multiple diseases. “Although broad strategies are useful and are impactful in the long-run, they may not necessarily provide with immediate action in case of an infectious disease emergency in the short run. We need policies that have provision for rapid response during an emergency situation such as an epidemic,” the researcher said.
The budgetary cut for institutions under the Council for Scientific and Industrial Research (CSIR) has evoked criticism from scientific community. Such budgetary curbs can adversely impact quality research and implementation of national science policies.
The experts have also emphasised the need for development and validation of newer, cost-effective and rapid tools for diagnosis of diseases.
India has not succeeded in controlling many old, new, or resurgent infectious diseases. “The cause of this deficiency is the health system, which, although focused on technologically advancing medical care for the urban elite population, lacks an adequately functional public health infrastructure that is essential for prevention of disease in all communities,” says a study published in Lancet.
Big gaps in the surveillance and response system for infectious diseases need to be addressed, it says.
The health system in India has to be modified with a major focus on public health in addition to the current focus predominantly on medical care. “Prevention and control of infectious diseases require a public health infrastructure, a cadre structure, professional leadership, trained human resources, and adequate economic investment. Incrementally adding new programmes will not solve the fundamental systemic deficiency,” the Lancet study says.
According to Global Health Security (GHS) Index, 2019, India is among the least prepared countries in terms of tackling any outbreak of infectious diseases.
Thailand and South Korea were among the best-performing countries in Asia, while India was at 57th rank with a score of 46.5.
A project of the Nuclear Threat Initiative (NTI) and the Johns Hopkins University Center for Health Security, with research by The Economist Intelligence Unit, the GHS Index is the first comprehensive assessment of epidemic and pandemic threats globally.
Built around a framework of 140 detailed questions, the Index assesses each country’s capacity to prevent, detect and respond to health emergencies, as well as the efficacy of their health systems, commitment to global norms, and the political, socioeconomic and environmental risk factors that can limit response.
The chairperson and managing director of Biocon, Kiran Mazumdar Shaw, has called for creation of virus repository with genomic data which will be useful in developing diagnostics and vaccines.
“We need to combine India’s world-class IT prowess in mining infectious diseases data to crack the genetic code of pandemic-causing viruses. Combining this knowhow with advanced medical technologies will enable us to develop a battery of low-cost rapid diagnostic tests for various infectious diseases,” Shaw says.
“The current crisis has reiterated the fact that healthcare and life sciences is the biggest opportunity for a country like India. GoI needs to seize this moment to redirect its focus on biotechnology, life sciences and healthcare, and work together with the private sector to make India not only the ‘Pharmacy of the World’ but also the ‘Laboratory of the World’,” she said.